| NPI | 1023280476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC3349) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC30120) |
| Enumeration Date | 2008-03-26 |
| Last Update Date | 2021-11-04 |